| NPI | 1629339312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 0074256) |
| Additional Taxonomies | 2086S0129X (Licence: PA MD455370) |
| 2086S0129X (Licence: NY 304339) | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2025-10-29 |